A comparison between laterally wedged insoles and ankle-foot orthoses for the treatment of medial osteoarthritis of the knee: A randomized cross-over trial.
Martin Schwarze, Leonie P Bartsch, Julia Block and 4 others
PMID 33781101WHAT IT FOUND
Ankle-foot orthoses reduced medial knee load more effectively than lateral wedge insoles in gait lab tests.
However, neither device improved patient-reported pain or function significantly more than the other, and overall clinical gains were small for both groups.
Key findings
01Both devices reduced the first peak of the external knee adduction moment, but the reduction was significantly greater with the ankle-foot orthosis than with the lateral wedge insole.
02Patient-reported outcomes for pain and function showed small improvements with both devices, but there was no significant difference between the ankle-foot orthosis and the lateral wedge insole.
03The biomechanical advantage of the orthosis did not translate into better clinical symptoms, leaving the link between lab-measured load reduction and patient experience unclear.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was underpowered, with 39 participants analyzed against a calculated need for 47. The lack of blinding may have influenced patient-reported outcomes. The cross-over design lacked a washout period, though no carryover effects were detected. The short six-week duration may not capture long-term effects on disease progression or patient adaptation.
Declared interests
The study was funded by Deutsche Arthrose-Hilfe e.V. The ankle-foot orthoses used were provided on loan by the manufacturer Otto Bock Health Care. The authors declared no other potential conflicts of interest.
The easy way to misread this
Do not assume that greater biomechanical correction leads to better patient outcomes. The ankle-foot orthosis reduced knee load more effectively in the lab, but this did not result in significantly better pain or function compared to lateral wedge insoles.